Possible ICD-10 Delay Rankles IT Industry

LAS VEGAS -- The possible delay in implementing the new ICD-10 medical coding system may please physicians, but the health information technology (IT) industry -- which has been gearing up for the shift -- is not so thrilled.

Last week, when Centers for Medicare and Medicaid (CMS) Acting Administrator Marilyn Tavenner hinted at a delay in the October 2013 implementation of the ICD-10 at the AMA's National Advocacy Conference the crowd welcomed the news.

But the ICD-10 delay is not being applauded here at the Healthcare Information and Management Systems Society (HIMSS) conference, where more than 34,000 attendees are meeting to network, discuss federal health IT regulations, and get a sneak peak at the newest health IT gadgets.

Heichert said the companies that are working on coding software and the health systems that have been knee-deep in ICD-10 preparations aren't going to put their efforts on hold because of the likely delay.

"We tend to gear up and we have a lot of moving pieces in place," she told reporters during a Tuesday morning briefing. "It's costly to stop a train from moving forward. No matter what that deadline is, if it's two years out or 10 years out, it's going to be too hard to get it geared up again."

Stephen Lieber, President and CEO of HIMSS, said he didn't think the delay would apply to all doctors. Lieber noted that when Department of Health and Human Services Secretary Kathleen Sebelius expanded on Tavenner's comments, she said the delay may apply to "certain providers."

"I'm hoping there's a little bit of thoughtfulness going into the government's decision here, recognizing that there are provider organizations who've put a lot of effort [into ICD-10 implementation]," he said during the same briefing. "This is actually not a good move for certain providers."

In fact, in a survey of 302 hospital IT executives presented Tuesday, nearly 90% said they expected to complete their ICD-10 conversion by the October 2013 deadline. (The question was asked several months ago, before it was announced that the October date would likely be pushed back.)

Larger hospitals likely have greater resources and staff to actively prepare for ICD-10 -- which has five times as many codes as the ICD-9 -- than do smaller facilities such as small physician practices.

Mitchell Adler, MD, an internist at a multi-specialty practice in New York City, is both a doctor and a health IT expert. He was a computer science major before going to medical school and championed the use of electronic medical records in his practice, which has been using them since 1998.

Adler told MedPage Today that he was not expecting HHS to push the ICD-10 start date back.

"I'm surprised," he said. "Maybe I'm ignorant, but I didn't think it would be a big lift," he said.

Although he acknowledged that doctors who haven't made the move to an electronic health record (EHR) may have a difficult time, he said that for those who are already using one, the ICD-10 transition will only mean that more specific code options appear on the screen when a physician enters a diagnosis code.

It doesn't mean that doctors will have to remember five times the number of codes, Adler said. Nor will they be doing the programming themselves. Their EHR vendor would be handling that.

Disagreeing with the ease of the process for even EHR-savvy physicians is Michael Zaroukian, MD, PhD, an East Lansing, Mich., internist and chair of the American College of Physicians' Medical Informatics Committee and the AMA's Health Information Technology Advisory Group.

He said adding more codes would indeed complicate day-to-day practice. He also questioned whether adding more codes will improve the health of patients.

"Lots of [ICD-10] will help coders and billers, but some of it doesn't improve the quality of care," he told MedPage Today.

Zaroukian said he's glad to see the delay, but said it does send a somewhat mixed message to physicians.

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